“I don’t know.” Aside from bad news, “I don’t know” is the worst thing a doctor can say to a patient, but it’s unfortunately the most usual thing, too. I took a deep breath and turned to my medicine shelves.
“Oh, God,” Bree said, the genuine apprehension in her voice tinged with reluctant amusement. “You’re getting out more whisky. It must be serious.”
“Well, if you don’t want any, I do,” I said. I’d chosen the good stuff, the Jamie Fraser Special, rather than the strictly medicinal whisky I gave the patients, and the scent of it rose warm and lively, displacing the smells of turpentine, scorched metal, and pollen-laced dust.
“Oh, I’m pretty sure I do.” She took the tin cup and inhaled the comforting fumes, her eyes closing involuntarily and her face relaxing.
“So,” she said, raising an eyebrow. “What do you know?”
I rolled my own whisky slowly round my tongue, then swallowed, too.
“Well, as I said, atrial fibrillation is a matter of irregular electrical impulses. Your heart muscle is sound, but it’s—once in a while—getting its signals crossed, so to speak. Normally, all the muscle fibers in your atria contract at once; when they don’t get a synchronized message from the electrical node in your heart that supplies them, they contract more or less at random.”
Brianna swallowed another sip, nodding.
“That’s pretty much what it feels like, all right. But you said it’s not dangerous? It’s freaking scary.”
I hesitated, a fraction of a second too long. No one but Jamie was more sensitive to the transparency of my face, and I saw the alarm rise again at the back of her eyes.
“It’s not very dangerous,” I said hastily. “And you’re young and very fit; it’s much less likely.”
“What’s less likely?” She put down the cup, agitated, and glanced involuntarily up at the ceiling; Mandy was back in the children’s room just overhead, loudly singing “Frère Jacques” to her doll Esmeralda.
“Well … stroke. If the atria don’t contract properly for too long—they’re meant to squeeze blood down into the ventricles; the right ventricle pumps blood to the lungs, the left to the rest of the body—” Seeing her ruddy brows draw together, I cut to the chase. “Blood can pool in the atria long enough that it forms a clot. And if so, it might dissolve before it gets out into the body, but if not …”
“Curtains?” She took a much bigger gulp of her drink. She’d been pale as a fish belly after the attack, and looked much the same way now. “Or just being disabled, so I drool and can’t talk and people have to feed me and drag me around and wipe my butt?”
“It’s not likely to happen,” I said, as reassuringly as possible, which under the circumstances was not all that reassuring. I could visualize the hideous possible outcomes as well as she was obviously doing. Somewhat better, in fact, as I’d actually seen a good many people suffering the aftereffects of stroke, including death. I had a momentary absurd impulse to tell her a fascinating fact about men who die of stroke, but this wasn’t the time.
“So what can you do about it?” she asked, straightening up and firming her lips. I saw her eyes turn toward the bulk of the new Merck Manual, and I handed it to her.
“I’m not sure,” I said. “Have a look.” I wasn’t hopeful, given what atrial fibrillation actually was—an intermittent derangement of the heart’s electrical system.
“I mean,” I said, watching her thumb through the book, brows furrowed, “you can stop a severe attack—one that goes on for days—”
“For days?” she blurted, looking up wide-eyed. I patted the air.
“You don’t have that sort of fibrillation,” I assured her. Mind, you can always develop it … “You just have the minor, paroxysmal kind that comes and goes and may just disappear altogether one day.” And God, please, please let it do just that …
“But for a severe attack, the normal treatment in the 1960s was to administer an electric shock to the heart with paddles applied to the chest. That makes the fibrillating stop and the heart start working normally again.” Most of the time …
“Which we plainly can’t do here,” Bree said, looking round the surgery as though estimating its resources.
“No. But I repeat—you don’t have anything as severe as that. You won’t need it.” My mouth had dried at the remembered visions of cardioversion. Even when it worked, I’d seen a patient shocked repeatedly, the poor body seized by electricity and jerked high into the air, to fall back limp and tortured onto the table, only to face another round when the EKG pen fluttered like a seismograph. I gulped the rest of my whisky, coughed, and set down the cup.